A client with chronic HFrEF presents with severe dyspnea, pink frothy sputum, BP 168/98, HR 124, SpO2 84 percent on RA, bilateral crackles to mid-fields. Which interventions should the nurse anticipate? Select all that apply.
Select All That Apply
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Explanation
Acute cardiogenic pulmonary edema treatment: high Fowler position with legs dependent reduces preload; noninvasive positive pressure ventilation (BiPAP/CPAP) improves oxygenation and reduces intubation rates; IV loop diuretic for volume removal; IV nitroglycerin reduces preload AND afterload, especially helpful with hypertension. Morphine is now used SELECTIVELY (concerns about increased mortality). Saline boluses are CONTRAINDICATED — they worsen volume overload. Inotropes are reserved for cardiogenic shock with hypotension.
LMNOP mnemonic: Lasix, Morphine (selective), Nitrates, Oxygen/NIV, Position upright. Watch for cardiogenic shock — these patients may need inotropes plus mechanical support.
Awake but anxious. Echo EF 25 percent. Last loop diuretic 12 hours ago. No prior intubation.
cardiogenic pulmonary edema — Pulmonary congestion from elevated left-heart pressures.
NIV — Noninvasive positive pressure ventilation; CPAP or BiPAP via face mask.
preload — Volume in ventricle at end of diastole; reduced by nitrates, diuretics, upright position.